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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH & SERVICES - OREGON

MEDICARE: PROVIDENCE HEALTH & SERVICES - OREGON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568793313
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH & SERVICES - OREGON
Provider Business Mailing Address
First Line : PO BOX 31001 - 4180
Second Line :
City : PASADENA
State : CA
Zip : 91110-4180
Country : US
Telephone Number : 425-358-9786
Fax Number : 503-215-6644
Provider Business Practice Location Address
First Line : 17550 PROVOST ST STE 201
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97034-5199
Country : US
Telephone Number : 503-513-3350
Fax Number : 503-513-3355
Authorized Official
Title or Position : ASSISTANT SECRETARY ENROLLMENT
Name : DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 01/19/2010
Last Update Date : 03/23/2026

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Directions to “PROVIDENCE HEALTH & SERVICES - OREGON ” Practice Location

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